Comparison of a self-rated and a clinician-rated measure for identifying depression among adolescents in a primary-care setting.

OBJECTIVE: To compare the diagnostic accuracy of a self-rated and a clinician rated measure of depression for primary care use in school setting by pediatricians. METHODS: Two tools for screening depression were administered to early adolescents in three schools. These included the self-rated Beck Depression Inventory (BDI), pediatrician rated Children's Depression Rating Scale-Revised (CDRS-R), and ICD-10 clinical interview by a psychiatrist as reference standard. These tools were compared for their overall performance using Areas Under the Curve (AUC) of Receiver Operating Characteristic (ROC) curves. The optimal screening threshold score for both tools were identified from their sensitivity and specificity plotted for all threshold scores. For the optimal cut-off scores, the diagnostic accuracy parameters like sensitivity, specificity, predictive values, likelihood ratio and diagnostic odds ratio were calculated using contingency table. RESULTS: The area under the curve for BDI was 0.67 and CDRS was 0.50 suggesting that BDI as a screening tool has better diagnostic accuracy. The optimal screening threshold score for BDI was 18 with a sensitivity of 63 and specificity of 70. For the CDRS-R cut-off score of 59, the sensitivity was 36 and specificity was 82 respectively. Using both tools concurrently improved the diagnostic accuracy. CONCLUSIONS: Using the ROC characteristics and various validity indices, the authors showed that BDI has better sensitivity and CDRS-R a better specificity. It might be prudent to use both these instrument simultaneously to improve the identification of depression in primary care settings like school health clinic.

Association between neuropsychiatric morbidity and streptococcal infections in children.

We conducted a case control study to study the association between neuropsychiatric morbidity and group A streptococcal infections in children. Twenty two cases of neuropsychiatric morbidity were compared with 64 controls. Fourteen (63.6%) of the 22 cases were positive for ASO and/or ADNB while 21 of the 64 controls (32.8%) were positive for either or both antibodies (OR = 3.428; CI: 1.15-10.18; P=0.026). We conclude that there is a statistically significant association between neuropsychiatric morbidity and streptococcal infection in children.

Comparative effectiveness of tepid sponging and antipyretic drug versus only antipyretic drug in the management of fever among children: a randomized controlled trial.

OBJECTIVE: To compare the effectiveness of tepid sponging and antipyretic drug versus only antipyretic drug among febrile children. DESIGN: Randomized controlled trial. SETTING: Tertiary care hospital. PARTICIPANTS: 150 children 6 mo - 12 yr age with axillary temperature 101F. INTERVENTION: Tepid sponging and antipyretic drug (Paracetamol) (n=73) or only antipyretic drug (Paracetamol) (n=77). MAIN OUTCOME MEASURES: Reduction of body temperature and level of comfort. RESULTS: The reduction of body temperature in the tepid sponging and antipyretic drug group was significantly faster than only antipyretic group; however, by the end of 2 hours both groups had reached the same degree of temperature. The children in tepid sponging and antipyretic drug had significantly higher discomfort than only antipyretic group, but the discomfort was mostly mild. CONCLUSION: Apart from the initial rapid temperature reduction, addition of tepid sponging to antipyretic administration does not offer any advantage in ultimate reduction of temperature; moreover it may result in additional discomfort.

Long segment Hirschsprung's disease in the Waardenburg-Shah syndrome.

Presentation with signs of bowel obstruction in an infant with Waardenburg syndrome should raise the suspicion of aganglionosis. We report such a case of long segment Hirschsprung's disease associated with Waardenburg syndrome. Long term care of such children is fraught with high morbidity and mortality.

Acute pancreatitis in a child with idiopathic ulcerative colitis on long-term 5-aminosalicylic acid therapy.

Acute pancreatitis is a rare but known complication of inflammatory bowel disease in adults. In children, only a few cases with this complication have been reported. We describe a 10-year-old boy with ulcerative colitis who developed acute pancreatitis while on long-term treatment with 5-aminosalicylic acid.

Disappearing CT lesions in focal seizures.

A case of focal seizures with right hemiparesis in a 6-year-old Indian girl is presented. CT scan showed four ring-enhancing lesions in the left cortex. She was treated with phenytoin and a course of praziquantel. The hemiparesis recovered in 3 weeks and a repeat CT scan after 2 months was normal. Arbitrary use of anti-tuberculous therapy in Indian children with focal lesions in the brain is not recommended as the lesions are often due to cysticercosis.

Poliovirus infection and Bell's palsy in children.

During a 16-months study period at Vellore, South India, three out of five children presenting as 'Bell's palsy' were suffering from poliomyelitis. In polio-endemic countries, poliomyelitis should be considered when children present as 'Bell's palsy'.